Critique Research Article: The Need for better Research Studies for proper Resource Rationing in Elderly Care Institutions

Introduction

There is an increasing scarcity of resources in healthcare while the demand for these services is increasing. Hence, choosing to ration resources by determining how to distribute them across various healthcare programs is becoming inevitable (Martin, 2015). Resource providers such as the government need to be well informed about the supply and demand for healthcare services in order to make well-informed decisions that will guide rationing. More so, these providers need to be informed of how the rationing policies in place are affecting patient safety for proper improvements. In this regard, there are many studies being developed to inform the reality of these policies (Scott, et al., 2018). The article “Missed care in residential aged care in Australia: An exploratory study” Henderson, et. al. (2017) explored the nursing care services that are rationed in residential aged care institutions in Victoria, South Australia, and New South Wales. While the article established that rationing mainly involved the number of registered nurses required to attend to residents, the limitations of the study affected the applicability of the research findings in this context. The article by Henderson, et al. (2017) is found at Elsevier database and the authors Julie Henderson and her colleagues are lecturers at the Flinders University in Australia in the departments of social health sciences and school of nursing & midwifery.

Critique Section

Research purpose

Belardi (2013) informs that the Australian government needs a good research study conducted to determine the intensity of missed nursing care in elderly care facilities mainly caused by resource rationing processes. Presently, the research studies conducted have provided unreliable results. What new studies need to focus on is on the intensity of missed care that is negatively affecting the services provided by the elderly care institutions. Good qualitative and quantitative research studies on the level of missed nursing care in the institutions are needed. The government is in need of making the reforms made in favor of the elderly persons better by improving rationing in their favor or completely abolishing rationing in their facilities.

Concepts gathered from the Literature Review

The concepts that Henderson, et al. (2017) gather from different literatures most of which are current, is that with good leadership and management practices, missed nursing care issues can be addressed even with a reduced number of registered nurses. However, where there is proper management of fewer resources, rationing tends to be increased attracting the occurrence of missed nursing care. When that occurs, nurses tend to perform well in timed tasks and poorly in untimed tasks. In residential care, rationing of resources is rare. In these facilities, there are a sufficient number of registered nurses, but these nurses prioritize on the tasks they do. Hence, any missed nursing care is considered as an unnecessary task. In Australia, residential care homes are mostly private institutions that are supported by the not-for profit organizations. Due to the increased demand for elderly care, the government also offers subsidies to these institutions and that has resulted to a rapid growth of for-profit residential care homes. Hence, in order to make profits, there has been a tendency to have fewer registered nurses in these institutions and having more of unqualified workers that are cheaper to employ.

Contents of the Article by Henderson, et al. (2017)

Theoretical framework

Henderson, et al. (2017) have not stated any theoretical framework for their study. Nevertheless, one that might be suitable for the article is that the motive behind rationing the number registered nurses in Australian residential care homes is profit making and not rationing because there is a scarcity of registered nurses.

Research question/variables

The research question that Henderson, et al. (2017) strive to answer is to establish if missed nursing care in residential care homes  is due to the normal healthcare rationing taking place due to scarcity of resources. The independent variables are two and they are- fewer registered nurses and a higher number of unskilled workers. The dependent variable is patient safety. The use of unskilled workers in handling tasks that affect patient safety is high due to poor regulations by governing authorities. Thus, the variables identified are concrete and measurable.

Methodology

The research method used by Henderson, et al. (2017) seems to have been ineffective in answering the research question. The researchers used cross-sectional survey methodologies to gather data using questionnaires from nurses working in these institutions and those that assist them. The study covered residential care homes located in three different Australian states. Out of 6454 participants randomly approached, only 922 responded and this made the researchers use a smaller sample size whose results could not be generalized following the fact that there are about 139,000 nurses working in the country. However, all subjects approached had equal chance of participating in the research study. The use of the MISSCARE survey tool also produced results that were not relevant to the study. Following ethical approvals, it is assumed that ethical considerations were made.

Data analysis

In the questionnaires used to collect data, researchers used a scaling tool to rate the frequency of missed nursing care. From the qualitative study, researchers used open-ended questionnaires that provided descriptive data to gather more information of what participants perceived were the reasons for missed nursing care. Where needed, results were presented in a tabulated format to make it easier to understand them. Apart from rationed number of registered nurses, patient safety was also affected by use of poor equipments or inadequate equipments.

Conclusion

Despite the resolution that the research findings are not relevant to answer the research question, the researchers conducted a systematic review on a number of articles that have attempted to determine the reasons for missed nursing care in general and in residential care. From the systematic review, it is established where the MISSCARE survey tool is and is not appropriately used. That is in addition to being familiar with the limitations that future researchers are likely to face when they will attempt to conduct related projects. Since very few respondents participated, the populations studied cannot be generalized as the results could be biased. In nursing, the results could be used to discourage the growth of for-profit residential care institutions as they negatively affect patient safety and ultimately the nursing profession.

Recommendations

In order for the rationing processes employed to manage scarce resources well to be effective, researchers need to limit their scope on where such processes are employed especially in the public health institutions. In addition, proper research designs need to be used to improve reliability, applicability, and validity of their study findings. That is, patients need to be included in the study, videos can be used to collect data, the sampling process also need to be improved, and others. Another recommendation is that, researchers in this field need to understand the pressing research needs that are after ensuring patient safety in elderly care.

References

Belardi, L. (2013). Renewed call to abolish aged care rationing. Retrieved< https://www.australianageingagenda.com.au/2013/11/01/renewed-call-to-abolish-aged-care-rationing/>.

Henderson, J., et al. (2017). Missed care in residential aged care in Australia: An exploratory study. Collegian, 24, 411-416. Retrieved https://www.collegianjournal.com/article/S1322-7696%2816%2930078-6/pdf.

Martin, E. (2015). Rationing in healthcare. Retrieved https://ahha.asn.au/sites/default/files/docs/policy-issue/deeble_issues_brief_no_8_martin_e_rationing_in_healthcare.pdf.

Scott, P.A., et al. (2018). Resource allocation and rationing in nursing care: A discussion paper. Nursing Ethics, XX(X), 1-12. Retrieved http://journals.sagepub.com/doi/pdf/10.1177/0969733018759831.